An applicant for U.S. citizenship holds an American flag during a naturalization ceremony at the Evo A. DeConcini U.S. Courthouse in Tucson, Arizona, U.S., on Friday, Sept. 16, 2016. From October 2015 through June 2016, 718,000 legal permanent residents applied for citizenship, up 8 percent compared to the same period leading up to the 2012 presidential election, according to federal data. Photographer: David Paul Morris/Bloomberg

A health insurer group wants the U.S. Department of Homeland Security to keep legal use of public health insurance programs out of immigration eligibility decisions.

America's Health Insurance Plans (AHIP) has filed a comment letter asking the department to continue to exclude use of those programs when deciding whether legal immigrants are likely to become “public charges,” or people who rely on government welfare programs to survive.

Keith Fontenot, AHIP's new executive vice president of policy and strategy, wrote the letter, in response to draft public charge regulations that the Homeland Security Department released in September.

“The proposed rule is inconsistent with the nation's goal of encouraging a healthier population,” Fontenot writes. “The proposed rule would discourage people from obtaining the health coverage they are legally permitted to receive.”

Any efforts to discourage people, including legal immigrants, from getting care are likely to make chronic health problems worse, increase the odds that uninsured people will end up in emergency rooms, and push doctors and hospitals to provide more uncompensated care, Fontenot writes.

The economic analysis in the September draft includes only a look at federal government costs related to immigration processes, Fontenot adds.

AHIP believes a complete analysis would show that the proposed rule could increase state health care spending, and also increase individual and group major medical premiums, Fontenot writes.

A public charge primer

U.S. immigration laws and regulations already require would-be immigrants to show that they are unlikely to end up needing to use benefits from the government-funded programs that help the poor.

But immigration courts have been relying on a semiformal definition of the term “public charge” that was developed in 1999.

The U.S. Citizenship and Immigration Services (USCIS), an arm of the Homeland Security Department, posted draft regulations in September. Under the current rules, immigration courts look mainly at whether people seem likely to end up needing Medicaid nursing home benefits.

In the draft regulations, USCIS officials propose classify some types of health benefits, and other benefits, as “heavily weighted negative factors.” Those factors could be used, for example, to decide whether someone in the United States as a permanent resident could become a citizen.

USCIS officials suggested including Medicaid benefits, Children's Health Insurance Program (CHIP) benefits and use of the Medicare Part D drug program low-income subsidy.

USCIS officials suggested excluding Medical assistance for emergency medical conditions, short-term disaster relief, and help with getting vaccinations against communicable diseases.

In the draft regulations, officials do not list ACA premium tax credit subsidies or ACA cost-sharing reduction subsidies on the list of benefits that would be classified as heavily weighted negative factors.

Last summer, an earlier version of the draft did include ACA subsidies on the list of heavily weighted negative factors. A draft of a new version of Instructions for Supplement A to Form I-539 shows that, in the instructions for that form, USCIS officials would classify ACA premium tax credits as public benefits.

Comments on the proposal are due Monday.

Resources

A copy of the AHIP comment letter and a summary are available here.

The Regulations.gov docket folder for the “Inadmissibility on Public Charge Grounds” proposal is available here. The docket includes a copy of the text of the draft, and copies of more than 16,000 separate public comments.

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Leave health insurers out of immigrant eligibility, AHIP says

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